Abstract
Background
Cancer staging is integral to ensuring cancer patients receive appropriate risk-adapted
therapy. Discrete cancer staging using a structured staging form helps ensure accurate
staging, provides a single source of truth for staging information, and allows for
reporting to regulatory authorities. Our institution created pediatric oncology specific
discrete staging forms that have been shared with the broader Epic community. By November
2023, baseline utilization of the staging form for patients with leukemia or lymphoma
was 43%, and the override rate for our existing alert was 99.9%.
Objectives
Improve discrete documentation of cancer stage for patients with leukemia or lymphoma
within 60 days following initiation of chemotherapy to >80% by July 2024 as measured
by signed staging form.
Methods
Model for improving plan-do-study-act (PDSA) cycles was implemented, and statistical
process control charts were used to evaluate impact. The first intervention was educational
training to oncology providers. The second PDSA cycle involved sharing monthly individual
completion data with the primary oncologist regarding their personal patient metrics.
The third PDSA cycle involved removing the interruptive alert.
Results
Within 6 months, documentation of primary oncologist improved from 86 to 100%, and
initiation of staging form improved from 57 to 90%. Completion of signed cancer staging
form reached 80%. Patients marked as not needing staging increased from 5 to 17%.
Conclusion
Completion of a digital cancer staging form is important for continuity of care, and
to facilitate reporting to regulatory authorities, though frequent interruptive alerts
were an ineffective method for improving documentation. Education and data sharing
increased staging completion to near target, with ongoing efforts to reach the goal
of 80%.
Keywords
electronic health records and systems - clinical information system, clinical decision
support - clinical information systems, oncology domain - clinical care, pediatrics
domain - socio-technical aspects of
